Declining Life Expectancy – Gene Uzawa Dorio, M.D. – Guest Commentary

Many nations proudly tout “Life Expectancy” as a reflection of healthcare. In our country, this statistic has continually edged upward due to expanding technology, doctors/patient education, and vibrant emphasis on healthy lifestyles. A shift is occurring though as this number is destined to decline with hospital administrators, not physicians, making medical decisions impacting those who are the most vulnerable: Elder seniors in the ICU.

These patients have been targeted by unscrupulous business people converting them to palliative care, with a gateway into hospice. Why would this be financially beneficial to these administrators?

Hospitals are paid a fixed amount by Medicare determined by a DRG code (Diagnosis-Related Group). If a patient stays a short time, hospitals make money. Should the patient stay too long, they can lose money. If you are a hospital administrator hoping to increase your salary, bonus, or retirement, what would be the most expeditious means of increasing your profit margin? Get the patient out of the hospital ASAP!But if the patient is an elder senior in the ICU and critically ill, what other tactics can be used? Take advantage of patients and their families when they are emotionally susceptible; enlist a palliative team urging movement toward hospice; and exploit poor physician communication concerning end-of-life care.

Hospital organizations have employed lawyers to capitalize on loopholes in policies which protect patients. All hospitals have palliative care policies which clearly delineate application of services to patients, but some have been twisted allowing consultation by a team which exerts pressure on patients and families.

As a geriatric practitioner, I have patients in the ICU, and in the past more than 90% leave this unit and eventually go home. Now though, a team approaches the patient and family members proclaiming “pain”, “suffering”, and “discomfort” can only be mitigated by palliative care, then hospice. This sometimes comes without a doctor order or discussion.

No one knows how long a patient will live. But when options of medical care are not disclosed, patients and their loved ones who are under emotional duress are convinced there is no semblance of hope and are swayed toward end-of-life care. For hospitals, this provides an easy scheme opening a bed for the next DRG patient.

Some policies even allow evaluation of a patient if their length of stay in the ICU is too long and resources for patient care are straining hospital finances. This means if you are too sick, hospitals have the right to reduce care no matter what the wishes are of the patient, family, or doctor. Legal loopholes have opened an administration Death Panel, so be familiar with your hospital Palliative Care Policy.

Life Expectancy should increase due to advancing medical technology, improved drugs, more individuals insured, and better computerization. But the human element of greed will be a force placing ICU elder seniors in the crosshairs of danger. Unlike doctors, hospital administrators don’t take the Hippocratic Oath. Their allegiance is to themselves, or to their shareholders.

Patients and families must therefore be on heightened alert when they face critical illness. Be sure to openly discuss end-of-life wishes with family members and your doctor well before hospital admission. Understand illness brings on emotional stress, so decisions must be made with all options on the table. Don’t let paid hospital personnel under the guise of a palliative care banner persuade or manipulate your better judgement.

The practice of medicine has changed, and your healthcare interest may no longer be paramount in a hospital where you are admitted. In the future as Life Expectancy declines, hospital propaganda will point a finger at the public insinuating obesity, lack of exercise, or non-compliance are the problem, and not their financial greed.

Doctors, patients, and families must wade through this deception. Hospital administrators cannot be allowed to make us or our loved ones a declining statistic in Life Expectancy.

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Bernard W. Freedman, J.D.,M.P.H. is an attorney at law and an active member of the California State Bar since 1976. (State Bar number 70888). He has specialized in medical legal law and acted as consultant in clinical bioethics and...More...